- Email: [email protected]
Comparing diagnostic methods for mental disorders in China
Comment
Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Parkville, VIC 3052, Australia [email protected]
7
8
I declare that I have no conflicts of interest. 1 2 3
4
5
6
Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008; 371: 261–69. WHO. International Clinical Trials Registry Platform Search Portal. http://apps.who.int/trialsearch/ (accessed May 26, 2009). Rouse DJ, Caritis SN, Peaceman AM, et al. A trial of 17 alphahydroxyprogesterone caproate to prevent prematurity in twins. N Engl J Med 2007; 357: 454–61. Norman JE, Mackenzie F, Owen P, et al. Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): a randomised, double-blind, placebo-controlled study and meta-analysis. Lancet 2009; published online June 11. DOI:10.1016/S0140-6736(09)60947-8. Dodd JM, Flenady V, Cincotta R, Crowther CA. Prenatal administration of progesterone for preventing preterm birth. Cochrane Database Syst Rev 2006; 1: CD004947. Dodd JM, Flenady VJ, Cincotta R, Crowther CA. Progesterone for the prevention of preterm birth: a systematic review. Obstet Gynecol 2008; 112: 127–34.
9
10
11
12
Northen AT, Norman GS, Anderson K, et al. Follow-up of children exposed in utero to 17 alpha-hydroxyprogesterone caproate compared with placebo. Obstet Gynecol 2007; 110: 865–72. Crowther CA, Hiller JE, Doyle LW, Haslam RR. Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial. JAMA 2003; 290: 2669–76. Crowther CA, Doyle LW, Haslam RR, Hiller JE, Harding JE, Robinson JS. Outcomes at 2 years of age after repeat doses of antenatal corticosteroids. N Engl J Med 2007; 357: 1179–89. Crowther CA, Hiller JE, Doyle LW. Magnesium sulphate for preventing preterm birth in threatened preterm labour. Cochrane Database Syst Rev 2002; 4: CD001060. Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev 2009; 1: CD004661. Doyle LW, Crowther CA, Middleton P, Marret S. Antenatal magnesium sulfate and neurologic outcome in preterm infants: a systematic review. Obstet Gynecol 2009; 113: 1327–33.
Comparing diagnostic methods for mental disorders in China See Editorial page 1998 See Articles page 2041
In The Lancet today, Michael Phillips and colleagues1 present an investigation that was done in mainland China, and report a prevalence of psychiatric disorders that was higher than previously documented. The rare combination of size, stratified random sampling, very high response rate, and ascertainment of urban and rural samples within a medium-income country draws attention to the unusual nature of this dataset. Since most of the previous epidemiological studies in China have been undertaken by native investigators and the reports have been written in Chinese (five of seven studies cited by Phillips and colleagues1), this work provides western readers with an invaluable insight into the nature and distribution of mental disorders in China.
Today’s study1 had a two-stage design,2 and psychiatric diagnosis was established by a clinician-administered Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV-disorders (SCID).3 Use of clinicians as interviewers provided several advantages. First, it enabled greater validity in detection of rare disorders such as non-affective psychosis.4 Second, clinicians using the SCID were able to use flexible, semistructured questions in the local dialect, and therefore obtained more detailed information about symptoms than would have been obtained with completely structured clinical interviews.5 This advantage, as evidenced by our own work, is particularly important when interviewing illiterate, rural respondents who might speak one of many Chinese regional dialects.6
Regions of China
Instrument
Disorders assessed
Sampling
Response rate
Prevalence (any excluding NOS disorders)
WHO World Mental Health Survey Consortium (2004)6
Beijing, Shanghai
WMH-CIDI
Anxiety*, mood, substance use, intermittent explosive, adult persistence of conduct
Stratified multistage clustered area probability sample of household residents (Beijing, n=2633; Shanghai, n=2568)
Beijing 74·8%; Shanghai 74·6%
Beijing 9·1%†; Shanghai 4·3%†
Phillips et al1
Shandong province, Zhejiang province, Qinghai province, Tianshu prefecture in Gansu province
Screening with GHQ, and diagnostic interview with SCID
Stratified multistage random Anxiety, mood, substance use, psychotic, organic mental, other sampling of household residents GHQ, n=63 004; SCID, n=16 577) mental (somatisation, pain, hypochondriasis, adjustment)
Screening, 94·7%; diagnostic interview 94·2%
13·3%‡
GHQ=general health questionnaire. NOS=not otherwise specified. WMH-CIDI=World Mental Health Composite International Diagnostic Interview. SCID=Structured Clinical Interview for DSM-IV axis 1 diagnoses. *Without obsessive compulsive disorder. †12-month prevalence. ‡1-month prevalence.
Table: Comparison of published large studies on mental disorders in China
2002
www.thelancet.com Vol 373 June 13, 2009
Comment
In a study done by WHO in 14 countries,7 the prevalence of psychiatric disorders was substantially lower in two urban sites in China than the prevalence reported by Phillips and colleagues.1 In the study by WHO,7—unlike the current study but like previous large-scale psychiatric epidemiology studies—a fully structured diagnostic interview was administered by lay interviewers to assess the prevalence of mental disorders (the World Mental Health Composite International Diagnostic Interview [WMH-CIDI]8). Although the WMH-CIDI has several noteworthy methodological strengths8 and has shown acceptable reliability with the SCID for assessment of the 12-month prevalence of anxiety or mood disorders (κ values were 0·42 and 0·56, respectively, and areas under the receiver operator characteristic curve were 0·88 and 0·83, respectively),5 some authors suggest that with these two approaches different forms of psychiatric symptoms are selected as cases for epidemiological analysis.9 The fact that assessment methods administered by lay individuals do not entirely correspond with clinicianadministered methods raises the question of how much of the difference in reported prevalence is attributable to differences in methods. What type of advantage might be conferred in detection of disorders when clinicians have increased flexibility in asking questions about symptoms, particularly in a country such as China? To help address these questions, we compare the two studies1,7 in terms of the methods and findings (excluding the not otherwise specified disorders; table). The higher overall prevalence rates reported by Phillips and colleagues1 are probably not due to the fact that a broader array of disorders (including psychotic, organic, and other mental disorders) are assessed in their study, because these account for only a combined 1·5% of mental disorders. Rural and urban differences, although possibly accounting for some of the disparity in prevalence estimates between studies, are not likely to wholly account for this variation. Although the prevalence of psychiatric disorders is slightly higher in rural areas, the rates in urban areas reported in the study by Phillips and colleagues1 remain much higher than those reported in the WHO study.7 One explanation that could account for a higher prevalence is the substantially better response rate in the current study1 because survey non-responders have much higher rates of mental disorders than do respondents.10 However, we estimate that even if the rate of psychiatric disorders in nonwww.thelancet.com Vol 373 June 13, 2009
responders was eight-fold higher than the prevalence noted in the Shanghai study,7 the true rate would still be less than that reported by Phillips and colleagues.1 If these differences are unlikely to account for most of the variation, then what might? Phillips and colleagues1 attribute the difference to the fact that respondents in their study might “experience or express negative states in non-traditional ways” and to the procedure of “using a semistructured interview administered by clinicians (who were familiar with the local cultural context), allowing the questions to be rephrased”. Although the reliability and validity of the SCID has been questioned11 and an accepted gold standard clinical assessment for psychiatric diagnosis does not exist,12 Phillips and colleagues1 pose an argument for enhanced validity of the SCID in the Chinese context that we think is reasonable. DSM-IV assumes universality of standard diagnostic criteria with very little regard to cross-cultural variability.13 However, cultural prescriptions shape how distress associated with mental illness is expressed, interpreted, organised, and responded to within a local social context.14 Because the operationalisation of many DSM criteria during clinical interviewing requires at least some interpretation and clinical judgment,12 allowing experienced local clinicians to probe and assess whether an individual meets a certain symptom criterion enables a measure of ecological validity that is not likely to be matched by structured, lay-individual administered interviews. Today’s excellent study brings the issue of comparative validity of these two approaches to the fore in a novel and challenging context. We hope that psychiatric epidemiologists will continue to push forward the research needed to assess the comparative validity of these two approaches, particularly in non-western cultures. *Lawrence H Yang, Bruce G Link Department of Epidemiology, Columbia University, 722 West 168th Street, Room 1610, New York, NY 10032, USA [email protected] We declare that we have no conflicts of interest. 1
2
3
Phillips MR, Zhang J, Shi Q, et al. Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey. Lancet 2009; 373: 2041–53. Dohrenwend BP, Levav I, Shrout PE, et al. Socioeconomic status and psychiatric disorders: the causation-selection issue. Science 1992; 255: 946–52. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV-TR Axis I disorders. New York: Biometrics Research Department, New York State Psychiatric Institute, 2002.
2003
Comment
4
5
6
7
8
Kendler KS, Gallagher TJ, Abelson JM, Kessler RC. Lifetime prevalence, demographic risk factors and diagnostic validity of nonaffective psychosis as assessed in a US community sample. Arch Gen Psychiatry 1996; 53: 1022–31. Haro JM, Arbabzadeh-Bouchez S, Brugha TS, et al. Concordance of the composite international diagnostic interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. Int J Methods Psychiatr Res 2006; 15: 167–80. Xu MQ, Sun WS, Liu BX, et al. Prenatal malnutrition and adult schizophrenia: further evidence from the 1959–60 Chinese famine. Schizophr Bull 2009; 35: 568–76. WHO World Mental Health Survey Consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291: 2581–90. Kessler RC, Ustun TB. The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004; 13: 93–121.
9
10
11
12
13 14
Booth BM, Kirchner JE, Hamilton G, Harrell R, Smith GR. Diagnosing depression in the medically ill: validity of a lay-administered structured diagnostic interview. J Psychiatr Res 1998; 32: 353–60. Kessler RC, McGonagle KA, Zhao S. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 8–19. Williams JBW, Gibbon M, First MB, et al. The structured clinical interview for DSM-III-R (SCID) II: multisite test-retest reliability. Arch Gen Psychiatry 1992; 49: 630–36. Kessler, RC, Abelson J, Demler O, et al. Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). Int J Methods Psychiatr Res 2004; 13: 122–39. Mezzich JE, Kirmayer LJ, Kleinman A, et al. The place of culture in DSM-IV. J Nerv Ment Dis; 187: 457–64. Lee S. Socio-cultural and global health perspectives for the development of future psychiatric diagnostic systems. Psychopathology 2002; 35: 152–57.
Combating chronic disease in developing countries Published Online June 11, 2009 DOI:10.1016/S01406736(09)61074-6
For the 3four50 website see http://www.3four50.com/v2/
For the NHLBI website see www.globalhealth.nhlbi.nih.gov
2004
Globalisation has affected every aspect of modern life, and health and disease are no different. The global health landscape is rapidly shifting away from one dominated by infectious diseases to one characterised by various chronic conditions. These diseases— cardiovascular disease, cancer, type 2 diabetes, and chronic respiratory diseases—now cause more than half of all deaths worldwide, 80% of which occur in low-income and middle-income countries.1–3 If present trends continue unabated, annual deaths from chronic diseases will reach 41 million by 2015, and almost half of these will be in people younger than 70 years.4 Since the major causes of chronic diseases are known, half of these deaths are preventable.2 The health catastrophe provoked by this global surge of chronic disease is also an underappreciated cause of poverty that impedes the economic development of many countries.5,6 Thus, we believe it is vital that the international public health community makes chronic disease prevention a worldwide priority. We believe that a coordinated effort by national leaders will strengthen chronic disease prevention and control efforts.2,3,5,7–10 To address the globalisation of noncommunicable chronic cardiovascular and pulmonary diseases, the National Heart, Lung, and Blood Institute (NHLBI), a component of the US National Institutes of Health, has increased its commitment to reducing the global burden of chronic diseases by fostering collaborations with partners in the public and private sectors. Most recently, the NHLBI and UnitedHealth Group, one of the world’s largest health and wellbeing
companies, have forged a collaboration to counter chronic disease by supporting a collaborative global network of centres of excellence (COEs) in low-income and middle-income countries throughout the world. Our goal is to support research that will generate the evidence needed to inform policy decisions. Rigorous research undertaken at diverse sites will also enrich our basic understanding of disease causation and of the interplay between biological, environmental, and sociocultural contributors to public health. Our strategic, complementary effort grew from the common interests of the NHLBI and the UnitedHealth Group. We recognise that combating chronic disease requires crossing geographical, governmental, and organisational boundaries, and thus collaboration between public and private partners. In September, 2006, the UnitedHealth Group established a strategic priority to raise public and political consciousness about chronic disease in the developing world and to use its competencies to prevent and control chronic disease in those regions.11 From the beginning, the UnitedHealth Group partnered with the Oxford Health Alliance to fulfil that group’s communication objective with the 3four50 website (so named to highlight the three factors of poor diet, physical inactivity, and tobacco that cause the four conditions—cardiovascular disease, diabetes, chronic respiratory disease, some cancers—that account for more than 50% of global mortality).12 This website is a rich online resource for those interested in raising awareness about chronic diseases and in devising www.thelancet.com Vol 373 June 13, 2009
Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Parkville, VIC 3052, Australia [email protected]
7
8
I declare that I have no conflicts of interest. 1 2 3
4
5
6
Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008; 371: 261–69. WHO. International Clinical Trials Registry Platform Search Portal. http://apps.who.int/trialsearch/ (accessed May 26, 2009). Rouse DJ, Caritis SN, Peaceman AM, et al. A trial of 17 alphahydroxyprogesterone caproate to prevent prematurity in twins. N Engl J Med 2007; 357: 454–61. Norman JE, Mackenzie F, Owen P, et al. Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): a randomised, double-blind, placebo-controlled study and meta-analysis. Lancet 2009; published online June 11. DOI:10.1016/S0140-6736(09)60947-8. Dodd JM, Flenady V, Cincotta R, Crowther CA. Prenatal administration of progesterone for preventing preterm birth. Cochrane Database Syst Rev 2006; 1: CD004947. Dodd JM, Flenady VJ, Cincotta R, Crowther CA. Progesterone for the prevention of preterm birth: a systematic review. Obstet Gynecol 2008; 112: 127–34.
9
10
11
12
Northen AT, Norman GS, Anderson K, et al. Follow-up of children exposed in utero to 17 alpha-hydroxyprogesterone caproate compared with placebo. Obstet Gynecol 2007; 110: 865–72. Crowther CA, Hiller JE, Doyle LW, Haslam RR. Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial. JAMA 2003; 290: 2669–76. Crowther CA, Doyle LW, Haslam RR, Hiller JE, Harding JE, Robinson JS. Outcomes at 2 years of age after repeat doses of antenatal corticosteroids. N Engl J Med 2007; 357: 1179–89. Crowther CA, Hiller JE, Doyle LW. Magnesium sulphate for preventing preterm birth in threatened preterm labour. Cochrane Database Syst Rev 2002; 4: CD001060. Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev 2009; 1: CD004661. Doyle LW, Crowther CA, Middleton P, Marret S. Antenatal magnesium sulfate and neurologic outcome in preterm infants: a systematic review. Obstet Gynecol 2009; 113: 1327–33.
Comparing diagnostic methods for mental disorders in China See Editorial page 1998 See Articles page 2041
In The Lancet today, Michael Phillips and colleagues1 present an investigation that was done in mainland China, and report a prevalence of psychiatric disorders that was higher than previously documented. The rare combination of size, stratified random sampling, very high response rate, and ascertainment of urban and rural samples within a medium-income country draws attention to the unusual nature of this dataset. Since most of the previous epidemiological studies in China have been undertaken by native investigators and the reports have been written in Chinese (five of seven studies cited by Phillips and colleagues1), this work provides western readers with an invaluable insight into the nature and distribution of mental disorders in China.
Today’s study1 had a two-stage design,2 and psychiatric diagnosis was established by a clinician-administered Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV-disorders (SCID).3 Use of clinicians as interviewers provided several advantages. First, it enabled greater validity in detection of rare disorders such as non-affective psychosis.4 Second, clinicians using the SCID were able to use flexible, semistructured questions in the local dialect, and therefore obtained more detailed information about symptoms than would have been obtained with completely structured clinical interviews.5 This advantage, as evidenced by our own work, is particularly important when interviewing illiterate, rural respondents who might speak one of many Chinese regional dialects.6
Regions of China
Instrument
Disorders assessed
Sampling
Response rate
Prevalence (any excluding NOS disorders)
WHO World Mental Health Survey Consortium (2004)6
Beijing, Shanghai
WMH-CIDI
Anxiety*, mood, substance use, intermittent explosive, adult persistence of conduct
Stratified multistage clustered area probability sample of household residents (Beijing, n=2633; Shanghai, n=2568)
Beijing 74·8%; Shanghai 74·6%
Beijing 9·1%†; Shanghai 4·3%†
Phillips et al1
Shandong province, Zhejiang province, Qinghai province, Tianshu prefecture in Gansu province
Screening with GHQ, and diagnostic interview with SCID
Stratified multistage random Anxiety, mood, substance use, psychotic, organic mental, other sampling of household residents GHQ, n=63 004; SCID, n=16 577) mental (somatisation, pain, hypochondriasis, adjustment)
Screening, 94·7%; diagnostic interview 94·2%
13·3%‡
GHQ=general health questionnaire. NOS=not otherwise specified. WMH-CIDI=World Mental Health Composite International Diagnostic Interview. SCID=Structured Clinical Interview for DSM-IV axis 1 diagnoses. *Without obsessive compulsive disorder. †12-month prevalence. ‡1-month prevalence.
Table: Comparison of published large studies on mental disorders in China
2002
www.thelancet.com Vol 373 June 13, 2009
Comment
In a study done by WHO in 14 countries,7 the prevalence of psychiatric disorders was substantially lower in two urban sites in China than the prevalence reported by Phillips and colleagues.1 In the study by WHO,7—unlike the current study but like previous large-scale psychiatric epidemiology studies—a fully structured diagnostic interview was administered by lay interviewers to assess the prevalence of mental disorders (the World Mental Health Composite International Diagnostic Interview [WMH-CIDI]8). Although the WMH-CIDI has several noteworthy methodological strengths8 and has shown acceptable reliability with the SCID for assessment of the 12-month prevalence of anxiety or mood disorders (κ values were 0·42 and 0·56, respectively, and areas under the receiver operator characteristic curve were 0·88 and 0·83, respectively),5 some authors suggest that with these two approaches different forms of psychiatric symptoms are selected as cases for epidemiological analysis.9 The fact that assessment methods administered by lay individuals do not entirely correspond with clinicianadministered methods raises the question of how much of the difference in reported prevalence is attributable to differences in methods. What type of advantage might be conferred in detection of disorders when clinicians have increased flexibility in asking questions about symptoms, particularly in a country such as China? To help address these questions, we compare the two studies1,7 in terms of the methods and findings (excluding the not otherwise specified disorders; table). The higher overall prevalence rates reported by Phillips and colleagues1 are probably not due to the fact that a broader array of disorders (including psychotic, organic, and other mental disorders) are assessed in their study, because these account for only a combined 1·5% of mental disorders. Rural and urban differences, although possibly accounting for some of the disparity in prevalence estimates between studies, are not likely to wholly account for this variation. Although the prevalence of psychiatric disorders is slightly higher in rural areas, the rates in urban areas reported in the study by Phillips and colleagues1 remain much higher than those reported in the WHO study.7 One explanation that could account for a higher prevalence is the substantially better response rate in the current study1 because survey non-responders have much higher rates of mental disorders than do respondents.10 However, we estimate that even if the rate of psychiatric disorders in nonwww.thelancet.com Vol 373 June 13, 2009
responders was eight-fold higher than the prevalence noted in the Shanghai study,7 the true rate would still be less than that reported by Phillips and colleagues.1 If these differences are unlikely to account for most of the variation, then what might? Phillips and colleagues1 attribute the difference to the fact that respondents in their study might “experience or express negative states in non-traditional ways” and to the procedure of “using a semistructured interview administered by clinicians (who were familiar with the local cultural context), allowing the questions to be rephrased”. Although the reliability and validity of the SCID has been questioned11 and an accepted gold standard clinical assessment for psychiatric diagnosis does not exist,12 Phillips and colleagues1 pose an argument for enhanced validity of the SCID in the Chinese context that we think is reasonable. DSM-IV assumes universality of standard diagnostic criteria with very little regard to cross-cultural variability.13 However, cultural prescriptions shape how distress associated with mental illness is expressed, interpreted, organised, and responded to within a local social context.14 Because the operationalisation of many DSM criteria during clinical interviewing requires at least some interpretation and clinical judgment,12 allowing experienced local clinicians to probe and assess whether an individual meets a certain symptom criterion enables a measure of ecological validity that is not likely to be matched by structured, lay-individual administered interviews. Today’s excellent study brings the issue of comparative validity of these two approaches to the fore in a novel and challenging context. We hope that psychiatric epidemiologists will continue to push forward the research needed to assess the comparative validity of these two approaches, particularly in non-western cultures. *Lawrence H Yang, Bruce G Link Department of Epidemiology, Columbia University, 722 West 168th Street, Room 1610, New York, NY 10032, USA [email protected] We declare that we have no conflicts of interest. 1
2
3
Phillips MR, Zhang J, Shi Q, et al. Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey. Lancet 2009; 373: 2041–53. Dohrenwend BP, Levav I, Shrout PE, et al. Socioeconomic status and psychiatric disorders: the causation-selection issue. Science 1992; 255: 946–52. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV-TR Axis I disorders. New York: Biometrics Research Department, New York State Psychiatric Institute, 2002.
2003
Comment
4
5
6
7
8
Kendler KS, Gallagher TJ, Abelson JM, Kessler RC. Lifetime prevalence, demographic risk factors and diagnostic validity of nonaffective psychosis as assessed in a US community sample. Arch Gen Psychiatry 1996; 53: 1022–31. Haro JM, Arbabzadeh-Bouchez S, Brugha TS, et al. Concordance of the composite international diagnostic interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. Int J Methods Psychiatr Res 2006; 15: 167–80. Xu MQ, Sun WS, Liu BX, et al. Prenatal malnutrition and adult schizophrenia: further evidence from the 1959–60 Chinese famine. Schizophr Bull 2009; 35: 568–76. WHO World Mental Health Survey Consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291: 2581–90. Kessler RC, Ustun TB. The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004; 13: 93–121.
9
10
11
12
13 14
Booth BM, Kirchner JE, Hamilton G, Harrell R, Smith GR. Diagnosing depression in the medically ill: validity of a lay-administered structured diagnostic interview. J Psychiatr Res 1998; 32: 353–60. Kessler RC, McGonagle KA, Zhao S. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 8–19. Williams JBW, Gibbon M, First MB, et al. The structured clinical interview for DSM-III-R (SCID) II: multisite test-retest reliability. Arch Gen Psychiatry 1992; 49: 630–36. Kessler, RC, Abelson J, Demler O, et al. Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). Int J Methods Psychiatr Res 2004; 13: 122–39. Mezzich JE, Kirmayer LJ, Kleinman A, et al. The place of culture in DSM-IV. J Nerv Ment Dis; 187: 457–64. Lee S. Socio-cultural and global health perspectives for the development of future psychiatric diagnostic systems. Psychopathology 2002; 35: 152–57.
Combating chronic disease in developing countries Published Online June 11, 2009 DOI:10.1016/S01406736(09)61074-6
For the 3four50 website see http://www.3four50.com/v2/
For the NHLBI website see www.globalhealth.nhlbi.nih.gov
2004
Globalisation has affected every aspect of modern life, and health and disease are no different. The global health landscape is rapidly shifting away from one dominated by infectious diseases to one characterised by various chronic conditions. These diseases— cardiovascular disease, cancer, type 2 diabetes, and chronic respiratory diseases—now cause more than half of all deaths worldwide, 80% of which occur in low-income and middle-income countries.1–3 If present trends continue unabated, annual deaths from chronic diseases will reach 41 million by 2015, and almost half of these will be in people younger than 70 years.4 Since the major causes of chronic diseases are known, half of these deaths are preventable.2 The health catastrophe provoked by this global surge of chronic disease is also an underappreciated cause of poverty that impedes the economic development of many countries.5,6 Thus, we believe it is vital that the international public health community makes chronic disease prevention a worldwide priority. We believe that a coordinated effort by national leaders will strengthen chronic disease prevention and control efforts.2,3,5,7–10 To address the globalisation of noncommunicable chronic cardiovascular and pulmonary diseases, the National Heart, Lung, and Blood Institute (NHLBI), a component of the US National Institutes of Health, has increased its commitment to reducing the global burden of chronic diseases by fostering collaborations with partners in the public and private sectors. Most recently, the NHLBI and UnitedHealth Group, one of the world’s largest health and wellbeing
companies, have forged a collaboration to counter chronic disease by supporting a collaborative global network of centres of excellence (COEs) in low-income and middle-income countries throughout the world. Our goal is to support research that will generate the evidence needed to inform policy decisions. Rigorous research undertaken at diverse sites will also enrich our basic understanding of disease causation and of the interplay between biological, environmental, and sociocultural contributors to public health. Our strategic, complementary effort grew from the common interests of the NHLBI and the UnitedHealth Group. We recognise that combating chronic disease requires crossing geographical, governmental, and organisational boundaries, and thus collaboration between public and private partners. In September, 2006, the UnitedHealth Group established a strategic priority to raise public and political consciousness about chronic disease in the developing world and to use its competencies to prevent and control chronic disease in those regions.11 From the beginning, the UnitedHealth Group partnered with the Oxford Health Alliance to fulfil that group’s communication objective with the 3four50 website (so named to highlight the three factors of poor diet, physical inactivity, and tobacco that cause the four conditions—cardiovascular disease, diabetes, chronic respiratory disease, some cancers—that account for more than 50% of global mortality).12 This website is a rich online resource for those interested in raising awareness about chronic diseases and in devising www.thelancet.com Vol 373 June 13, 2009